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Combined Versus Deep Serratus Anterior Plane Block Shows No Difference in VATS Postoperative PainStudy finds similar pain relief from two nerve block techniques after chest surgery

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Key Takeaway
Consider deep SAPB alone as equivalent to combined approach for VATS analgesia in studied protocol.

A prospective randomized clinical trial at a single academic center enrolled 60 patients undergoing elective video-assisted thoracoscopic surgery (VATS). Patients were randomized to receive either a combined deep and superficial serratus anterior plane block (each injection of 15 mL 0.375% bupivacaine with epinephrine) or a deep serratus anterior plane block alone (30 mL of the same solution). All patients received additional local infiltration and standardized multimodal analgesia.

The primary outcome was not reported. Key secondary outcomes measured over 24 hours showed no statistically significant differences between groups. Total postoperative opioid consumption was 27.12 ± 16.67 mg morphine milligram equivalents in the deep block group versus 32.84 ± 19.86 mg in the combined block group (p = 0.137). Rescue analgesia requirements were 11.67 ± 11.47 mg versus 16.33 ± 12.45 mg (p = 0.141). Postoperative pain scores were similar (p > 0.05).

Safety assessment found the incidence of opioid-related adverse effects was similar between groups, with both techniques offering comparable safety profiles. Serious adverse events and discontinuations were not reported.

Key limitations include the single-center design, modest sample size of 60 patients, and lack of reported primary outcome. The study cannot claim superiority of either technique and findings may not generalize beyond VATS populations or different block protocols. For practice, a single deep serratus anterior plane block appears to provide equivalent postoperative analgesia to a combined approach in this specific surgical setting when used with supplemental local infiltration and multimodal analgesia.

Researchers wanted to see if combining two types of nerve blocks would work better than using just one type for pain control after a specific chest surgery called VATS. They studied 60 patients at one academic hospital who were having this elective surgery. All patients received standard pain medications along with the nerve blocks.

The study compared two groups: one group received a nerve block injected deep into a chest muscle, while the other group received the same deep block plus an additional, more superficial injection in the same area. The researchers then measured pain levels, how much opioid pain medication patients needed in the first 24 hours after surgery, and any side effects.

They found that both groups had similar pain scores, used similar amounts of opioid medication, and experienced similar rates of side effects like nausea. The main reason to be careful with these results is that this was a relatively small study at a single hospital. Both groups also received other standard pain control methods, which makes it hard to isolate the exact effect of the nerve blocks alone.

Readers should understand that this early research suggests both techniques may provide comparable pain relief for this specific surgery. It does not show that one method is better or safer than the other. More studies with more patients are needed before doctors can make definitive changes to how they manage pain after this type of operation.

What this means for you:
Two nerve block methods showed similar results for pain after chest surgery in a small, single-hospital study.

Study Details

Study typeRct
EvidenceLevel 2
PublishedApr 2026
View Original Abstract ↓
OBJECTIVES: This study aimed to compare the analgesic efficacy of a combined deep and superficial serratus anterior plane block (SAPB) with deep SAPB alone in patients undergoing video-assisted thoracoscopic surgery (VATS). DESIGN: A prospective, randomized clinical trial. SETTING: Single-center, academic hospital. PARTICIPANTS: Sixty patients undergoing elective VATS. INTERVENTIONS: One group received a combined deep and superficial SAPB (each 15 mL of 0.375% bupivacaine with epinephrine 5 µg/mL injected both deep to and above the serratus anterior muscle) (group DS), while the other group received 30 mL of the same solution deep into the serratus anterior muscle only (group D). Additionally, 5 mL of 0.25% bupivacaine was infiltrated at the chest tube insertion site in all patients. Standardized multimodal analgesia included intravenous morphine (0.1 mg/kg), paracetamol (1,000 mg), and ibuprofen (800 mg), administered 30 minutes before the end of surgery. Postoperative analgesia was maintained with intravenous patient-controlled fentanyl. MEASUREMENTS AND MAIN RESULTS: Demographic and operative characteristics were comparable between the groups. Total postoperative opioid consumption within 24 hours, expressed in morphine milligram equivalents, was 27.12 ± 16.67 mg in group D and 32.84 ± 19.86 mg in group DS, with no significant difference between groups (p = 0.137). The total amount of rescue analgesia was 11.67 ± 11.47 mg in group D and 16.33 ± 12.45 mg in group DS, with no statistically significant difference between the groups (p = 0.141). Postoperative pain scores and the incidence of opioid-related adverse effects were similar between groups (p > 0.05 for all). CONCLUSIONS: This study demonstrates that a single deep SAPB provides equivalent postoperative analgesia to combined single and deep SAPB. Both techniques offered comparable postoperative analgesia and safety profiles.
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